Blood Pressure Medication. Barbara Pfeifer Diabetes Programs Manager

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1 United Indian Health Services Blood Pressure Medication Titration Program Barbara Pfeifer Diabetes Programs Manager

2 Why a Medication titration program? Despite the many antihypertensive medications available, two-thirdsthirds of patients with hypertension do not achieve blood pressure control.

3 Reasons for not being treating to target can be: Cli ents not feeling sick + lack of hypertension health education + clinical inertia + Clients not taking their meds ========================= Uncontrolled hypertension

4 Purpose This protocol is intended to gain more rapid control of blood pressure by allowing titration of medications between clinic visits. This is achieved through a collaborative effort between the medical providers, nurse case managers and outreach workers.

5 Step 1- The Medical Provider completes the Blood Pressure Medication Titration Orders U N ITED IN D IA N H EA L TH S E RV IC E S, IN C. Diabetes Awareness Program Blood Pressure Medication Titration Orders Add/ Titrate Order Current med? Medicat cation Brand name Titration schedule(mg) usual starting dose Usual Sig ACE-I Enalapril Vasotec 2.5, 5, 10, 20, 40(2x20) QDay Lisinopril Prinivil, Zestril 2.5, 5, 10, 20, 30, 40, 80(2x40) QDay ARB Losartan Cozaar 25, 50, 100 QDay Valsartan Diovan 40, 80, 160, 320 QDay Diuretics Hydrochlorothiazide (HCTZ) 12.5, 25, 50 QDay Triamterene/HCTZ Dyazide, Maxzide 25/37.5, 50/75 QDay Ca Channel Blockers Amlodipine Norvasc 2.5, 5, 10 QDay Nifedipine ER Adalat CC, Procardia XL 30, 60, 90 QDay Diltiazem ER Cardizem LA 60, 90, 120, 180, 240, 300 QDay Verapamil ER Calan SR 120, 180, 240 QDay Beta Blockers Atenolol Tenormin 25, 50, 100 QDay Labetalol Trandate 100, 200, 300 BID Metoprolol XL Toprol XL 25, 50, 100, 200, 400(2x200) QDay Propranolol ER Inderal LA 60, 80, 120, 160 QDay Central agents Clonidine oral Catapres 0.1, 0.2, 0.3,, 0.6(2x0.3), 0.9(3x0.3), 1.2(4x0.3) BID Clonidine patch Catapres TTS 0.1, 0.2, 0.3, 0.6(2x0.3) 1x/wk Alpha Blockers Doxazosin Cardura 1, 2, 4, 8, 16(2x8) QDay Terazosin Hti Hytrin 1, 2, 5, 10, 20 (2x10) QHS Other Start Dose (Mg) Max Dose (Mg) Goal SBP is at or under 130 unless alternate goal entered here: Titrate medication every 2 weeks until at least 50% of SBP readings are at or under goal range Lab orders: BMP 2 week(s) after adding/increasing ACE/ARB/Diuretic Hold titration and contact provider for: HR less than 50 SBP less than 100 DBP less than 50 Chest pain/dyspnea Pre-syncopal/Syncopal episodes No medical visit in the last 6 months Persistent cough on an ACE-Inhibitor Other Provider Signature: Date: This order expires 6 months from the date of signing. Client Name: Client DOB: Client MR#:

6 Step 2 A referral is sent to the Diabetes Department. Step 3 The referral is assigned to the appropriate case manager. Step 4 Home visit Step 5 Diabetes Outreach Worker downloads monitor ~ every two weeks. Step 6 Medications titrated as needed.

7 UNITED INDIAN HEALTH SERVICES, INC. Diabetes Awareness Program Temporary Loan Agreement Of Blood Pressure Monitor United Indian Health Services, Inc. will loan a Blood Pressure Monitor to client for their participation in the Blood Pressure Medication Titration program The Blood Pressure Monitor is the property of United Indian Health Services, Inc. and any damages or an unreturned monitor will result in the client being charged a replacement cost of $70. By signing below, both the representative of United Indian Health Services, Inc. and the client agree that the borrowing party (client) takes full financial i responsibility for the Blood Pressure Monitor while on loan to them. The return of the Blood Pressure Monitor will be requested when titration of blood pressure medications have been completed. We acknowledge and accept the terms of this Temporary Loan Agreement: Client (Borrowing Party) Date: Date: United Indian Health Services, Inc. Representative

8 Omron HEM-790IT

9 Results 2009 Audit blood pressure control increased 8%. 2010Audit control increased 7%. 15% increase in clients with controlled hypertension in less than 2 years. Program spread beyond clients with diabetes.

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